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Organization
SOUTH LAKE PRIMARY CARE P A
Active
Organization
SOUTH LAKE PRIMARY CARE P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAMON SUEIRO MD (MEDICAL DIRECTOR)
(352) 557-4840
Entity
Organization
Contact information
Practice address
219 W MYERS BLVD, SUITE C, MASCOTTE, FL 34753-9793
(352) 557-4840
(352) 557-4839
Mailing address
1503 SUNRISE PLAZA DR, CLERMONT, FL 34714-6200
(352) 243-3800
(352) 243-3804
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0071348
FL
Other
Enumeration date
06/01/2012
Last updated
08/30/2013
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